Palliative care is aimed at reducing the pain and increasing the comfort of people being treated for a serious illness, regardless of their prognosis. If you didn't know that, you are not alone.
Studies have found that 70 percent of the U.S. public is unfamiliar with palliative care. Doctors also often are unaware of the spectrum of palliative care services. The 2013 Institute of Medicine report Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis notes that physicians often do not refer patients to palliative care until the last two months of life. Yet palliative care can be offered from the moment a patient begins cancer treatment.
Judith Redwing Keyssar, the director of the Palliative and End of Life Care Program at Jewish Family and Children’s Services of the San Francisco Bay Area, is on a mission to help people understand how palliative care can help prevent and treat cancer-related pain—whether a patient has a good or poor prognosis, a small tumor or metastatic disease, or is starting or ending active treatment. A nationally known speaker, Keyssar is also the author of Last Acts of Kindness, a book that explores attitudes about palliative care and end-of-life issues. Cancer Today spoke with Keyssar about using palliative care during cancer treatment.
Q: How do you explain palliative care to patients and their families?
A: I prefer to describe palliative care as an extra layer of support that comes along with the care that patients are already receiving. Palliative care is about holistically addressing a patient’s needs and relieving suffering on every level—physical, emotional and spiritual. Services are provided by an interdisciplinary team that can include physicians, pharmacists, complementary health providers, social workers and religious advisers.
Q: What are some of the common misconceptions about palliative care?
A: Many people confuse palliative care with hospice care, which has a palliative care component, but is typically offered in the last six months of life. Patients think that if they agree to receive palliative care, their disease won’t be treated. And doctors are sometimes hesitant about referring patients because they can’t understand what palliative care can provide that they can’t. They also may believe that they are somehow giving up on the patient. I see it all the time: Palliative care services are suggested, and the oncologist says, “We don’t need that yet.”
Q: When should patients start thinking about and requesting palliative care?
A: Patients should be offered palliative care services as soon as they’re diagnosed. Most hospitals have a palliative care team, but these services are often offered only to inpatients. Also, although anyone can request palliative care, in many cases a physician must make a referral, and he or she may be reluctant to do so.
When a patient is expected to go into remission after treatment, a palliative care consult makes all the sense in the world, because it covers everything from pain control and psychological concerns to practical issues, such as housing and transportation needs. Patients need to understand that palliative care isn’t about giving up on treatment—it’s about helping them get through treatment.
Q: Could you describe a time when palliative care helped a cancer survivor?
A: One of my patients was diagnosed with breast cancer in 1991. Our palliative care group has helped her through her many treatments, surgeries and recurrences by finding alternative housing, helping with pain and symptom management and providing emotional and psychological support. The assistance we offered has allowed her to focus more on her treatment and recovery. She feels secure and supported, and she knows that she can depend on us if her cancer comes back.
January 24, 2014